“Stella Raphael’s story is one of the saddest I know,” intones Dr. Peter Cleave, the senior psychiatrist in the mental hospital central to Asylum by Patrick McGrath. Asylum is a story of obsession.

Stella and her husband Max have moved outside London for Max’s job. Hoping to eventually become superintendent of the facility, Max is quite involved in the asylum’s day-to-day activities, and the couple’s home is on the property. Max has big plans, including renovating the conservatory and gardens of the home. Some of the better-behaved patients are allowed on work teams, and Edgar Stark, a former sculptor, is given the task of carpentry work in the conservatory. Charlie, Stella and Max’s son, is fascinated with the work and the gardens and the pond, spending many of his days outside. When Stella encounters Edgar while outside with Charlie, she is drawn to him. Edgar doesn’t look insane. He is polite and talented. The two become friendly, and Stella, lacking passion in her own marriage, falls in love with Edgar.

Edgar Stark is Cleave’s patient, and Edgar’s intelligence fascinates the doctor. Edgar murdered his wife and brutalized her body after suspecting her of multiple infidelities for many years. Edgar feels completely justified in his actions, and Cleave counts Edgar one of his more interesting patients because of this. It is only when Cleave observes subtle changes in Stella that he suspects the impossible. When Edgar escapes from the facility, Max and Stella both come under scrutiny, leading to a chain of events that is both disturbing and engrossing.

McGrath’s Asylum is an elegant novel. Gothic and dark, it explores the nature of love and obsession as well as mental illness. The novel is, in many ways, timeless, and particularly, it was some time before I could have stated with any assurance the time period in which Asylum is set. Late 1950s, to be exact.

Cleave is narrating the novel, yes, but he is doing so after discussions with Stella, after something has apparently gone badly wrong, and the impending sense of doom only adds to the novel’s complexity. Not that Asylum is a mystery. It isn’t. Edgar murdered his wife. He escapes from the asylum. Stella goes to him. Nothing surprising here. When Edgar begins exhibiting erratic behavior, though, she runs. However, the story doesn’t take the reader into the places you’d think it would. Stella is not repentant. Instead, she feels torn from her lover and sorrowful that she ever suspected his behavior. Willing, even after knowing the full extent of his crime, to go to him and be with him, and Cleave notes this:

At root, I suppose, in spite of everything she loved him, or told herself she did, and women are stubborn in this regard. She had made her choice, she had gone to him willingly, and it was unthinkable to run home because he was ill and his illness robbed him of responsibility. What did surprise me was that she could ignore the proliferating signals that an act of violence was imminent.

Just as Edgar seems to relish the idea of bedding a psychiatrist’s wife, so too does Stella enjoy her role as caretaker. Edgar is ill; therefore, Stella must take care of him, even if it means abandoning her husband and her child. The child she increasingly grows to resent because he is part of his father and therefore part of the imagined trap she feels exists around her.

If you have not yet picked up on it, this is an unreliable narrator speaking to another unreliable narrator. Both Stella and Cleave are obsessed with Stark, Cleave referring to Stark as “my Edgar” many times, a point of pride that Edgar is his patient. So we know what the characters intend to tell us, emphasizing that we never truly know the nature of anyone, much less someone with a mental illness.

The nature of these obsessions is, of course, destructive, and everyone involved hurtles toward that destruction in ways both expected and unexpected. I listened to this on audiobook, and I usually stick to my time on the elliptical only to listen to audiobooks. This was one, however, that after a certain point in Asylum, I had to put my headphones on for the rest of the day, no matter what else I was doing to absorb it all. Unlike Cleave, I don’t think Stella’s is the saddest story I know, and I had very little sympathy for her outside her feeling of entrapment, but I was still completely captivated by her ability to dismiss all rational thought in the face of the man she loves.

The narration by Ian McKellen is absolutely first rate, and Asylum is a story that will sink in slowly, insidiously, forcing you to think about the characters and their decisions long after the end.